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In modern WHO classifications of tumors of the central nervous system, endocrine and neuroendocrine tumors, the authors propose the definition \u00abpituitary neuroendocrine tumor\u00bb instead of previous \u00abpituitary adenoma\u00bb and \u00abmetastasizing pituitary neuroendocrine tumor\u00bb instead of \u00abpituitary carcinoma\u00bb. Currently, there are no effective prognostic markers of aggressive tumors. This complicates early diagnosis. It is proposed to apply a five-stage prognostic classification based on proliferation rate (including mitotic count, Ki-67 index and p53 immunoexpression) and morphometric markers of invasiveness for all resected pituitary neoplasms. This approach would be valuable for earlier detection of aggressive tumors and pituitary carcinomas. Compression of visual pathways, third ventricle and brain stem due to rapid growth of aggressive tumors usually requires redo surgeries with subsequent radiotherapy. Hormonally active tumors require therapy with somatostatin analogues and dopamine agonists in maximum possible doses. Chemotherapy with temozolomide as first-line option is recommended if standard treatment is ineffective. Alternative treatment includes peptide receptor radionuclide therapy (PRRT), molecular targeted therapy (bevacizumab, tyrosine kinase inhibitors, everolimus and cyclin-dependent kinase inhibitors) and immunotherapy (checkpoint inhibitors). Considering the need for combined treatment, these cases should always be discussed by a multidisciplinary team (neurosurgeon, endocrinologist, radiotherapist, oncologist, pathologist) with necessary qualifications and experience in treating these patients. Treatment of aggressive tumors and pituitary carcinomas is becoming an active and rapidly developing direction in neurosurgery, endocrinology and oncology.<\/jats:p>","DOI":"10.17116\/neiro202488031103","type":"journal-article","created":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T04:27:33Z","timestamp":1718598453000},"page":"103","source":"Crossref","is-referenced-by-count":2,"title":["Aggressive pituitary tumors and carcinomas: modern classification, advances and prospects in treatment"],"prefix":"10.17116","volume":"88","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4480-1902","authenticated-orcid":false,"given":"L.I.","family":"Astafyeva","sequence":"first","affiliation":[{"name":"Burdenko Neurosurgical Center","place":["Moscow, Russia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9333-9473","authenticated-orcid":false,"given":"P.L.","family":"Kalinin","sequence":"additional","affiliation":[{"name":"Burdenko Neurosurgical Center","place":["Moscow, Russia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7651-4214","authenticated-orcid":false,"given":"G.L.","family":"Kobyakov","sequence":"additional","affiliation":[{"name":"Burdenko Neurosurgical Center","place":["Moscow, Russia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4240-5036","authenticated-orcid":false,"given":"Yu.Yu.","family":"Trunin","sequence":"additional","affiliation":[{"name":"Burdenko Neurosurgical Center","place":["Moscow, Russia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7206-6365","authenticated-orcid":false,"given":"M.V.","family":"Ryzhova","sequence":"additional","affiliation":[{"name":"Burdenko Neurosurgical Center","place":["Moscow, Russia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6743","reference":[{"key":"key-10.17116\/neiro202488031103-1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-17-0796"},{"key":"key-10.17116\/neiro202488031103-2","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-020-09556-7"},{"key":"key-10.17116\/neiro202488031103-3","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad098"},{"key":"key-10.17116\/neiro202488031103-4","unstructured":"De Sousa SMC, McCormack AI. 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